The Study of Women's Health Across the Nation (SWAN) is a 7-center multi-ethnic longitudinal study designed to characterize the physiological and psychosocial changes that occur during the menopausal transition. SWAN has amassed ten years of data about endocrinology of the transition and other factors relevant to midlife health and aging. As SWAN requests its fourth competing renewal, the study itself proposes to transition from a study of the menopause to a study of aging in women. The average age of participants at the beginning of the SWAN IV project will be 59 years (54 to 65) and SWAN IV will follow these women through the age range of 59 to 70. SWAN has the unprecedented capability to link the expansive biological, medical, social, behavioral, and demographic data it has collected during mid-life and the menopausal transition to the development of both positive and adverse health states in early oldage. The primary objectives of SWAN IV are to: 1) Characterize the endocrinology and symptomotology of the post-menopause (2 to 12 years after final menses); 2) Ascertain additional health outcomes (such as measured physical performance) that are relevant to the early old age range and that may be affected by the factors that we have studied in mid-life and 3) Understand the relations between the mid-life and menopausal transition experience of women and subsequent positive and negative health outcomes. To accomplish this, the investigators propose annual phone contact to closely track menopausal status, menopausal symptoms and selected health events. In addition, two in-person clinic visits are proposed to accomplish detailed physical measures of early disease. The major thematic areas of SWAN IV include 1) Physical Functioning; 2) Bone/Osteoporosis; 3) Cognitive Function/ Symptoms/ Mental Health and 4) Cardiovascular. New areas for SWAN include physical performance and osteoarthritis, history of major depression, and carotid wall thickness. SWAN will continue to monitor symptoms, cognition, cardiovascular risk factors, endocrinology, bone density and fractures. SWAN IV will advance our understanding of how modifiable risk factors related to the menopause transition are linked to sub-clinical disease measures and hard outcomes. This may lead to improved strategies for the primary prevention of disease in women. RELEVANCE: SWAN has compiled the most comprehensive characterization to date of the health and the physiologic and psychosocial changes of women from pre- to postmenopause in community based samples. Of particular public health importance is that the continuation of SWAN will permit the study to increase understanding of the effects of these menopause-related changes on subsequent health and risk factors for age-related diseases.